基于HFMEA预防人工肝支持系统导管相关血流感染的效果评价  

Effect of HFMEA in prevention of catheter-related bloodstream infections in artificial liver support system therapy

作　　者：欧阳姗 何娜 王娟[1] 郑丽花[1] 郑子梅[1] 李莉莉[1] Ouyang Shan;He Na;Wang Juan;Zheng Lihua;Zheng Zimei;Li Lili(Department of Infection,Third Hospital,Sun Yat-sen University,Guangzhou 510600,China)

机构地区：[1]中山大学附属第三医院感染科,广州510600

出　　处：《国际医药卫生导报》2025年第2期340-344,共5页International Medicine and Health Guidance News

基　　金：中华医学会杂志社护理学科研究课题(CMAPH-NRG2022018)。

摘　　要：目的探讨医疗失效模式与效应分析(HFMEA)预防人工肝支持系统(ALSS)导管相关血流感染的效果。方法选取中山大学附属第三医院2022年1月至2023年12月行ALSS治疗的患者进行非随机对照试验,根据入院时间分成对照组(2022年1月至12月)和观察组(2023年1月至12月)。对照组338例,男283例,女55例,年龄(49.35±11.52)岁,采用ALSS导管常规护理。观察组389例,男323例,女66例,年龄(47.90±12.94)岁,应用HFMEA管理。两组均护理7 d。比较护理后两组患者ALSS导管相关血流感染失效模式风险系数(RPN)和发生率,实施HFMEA项目管理前、后科室护理人员ALSS导管维护理论和操作考核成绩。统计学方法采用t检验。结果护理后,观察组患者ALSS导管相关血流感染失效模式RPN与发生率均较对照组低[1592分比3980分、0.083‰(1/11984)比0.418‰(5/11952)]。实施HFMEA项目管理后,护理人员理论考核、操作考核成绩均高于实施前[(85.28±4.94)分比(75.56±9.72)分、(94.24±2.19)分比(84.24±2.19)分],差异均有统计学意义(t=6.490、23.506,均P<0.05)。结论应用HFMEA可前瞻性预见易导致ALSS治疗患者导管相关血流感染的高风险失效环节,降低导管相关血流感染事件发生率,提高护理人员导管维护能力。Objective To analyze the effect of healthcare failure mode and effect analysis(HFMEA)in the prevention of catheter-related bloodstream infections in artificial liver therapy.Methods The patients taking artificial liver therapy at Third Hospital,Sun Yat-sen University from January 2022 to December 2023 were selected for the non-randomized controlled trial.According to the admission time,the patients were divided into a control group(283 cases),treated from January two December 2022,and an observation group,treated from January to December 2023.There were 283 males and 55 females in the control group;they were(49.35±11.52)years old.There were 323 males and 66 females in the observation group;they were(47.90±12.94)years old.The control group took routine nursing care for artificial liver catheters.The observation group were managed with HFMEA.The risk priority numbers(RPN)of the healthcare failure mode of catheter-related bloodstream infections,incidence rates of catheter-related bloodstream infections,and scores of catheter maintenance theory and operation of the nursing staff were compared between two groups by t test.Results The RPN of the healthcare failure mode of catheter-related bloodstream infections and incidence rate of catheter-related bloodstream infections in the observation group were lower than those in the control group[1592 vs.3980 and 0.083‰(1/11984)vs.0.418‰(5/11952)].The scores of the nursing staff's theoretical and operational assessments were higher after than before the application of HFMEA(85.28±4.94 vs.75.56±9.72 and 94.24±2.19 vs.84.24±2.19),with statistical differences(t=6.490 and 23.506;both P<0.05).Conclusion The application of HFMEA can prospectively foresee the high-risk failure links that are prone to artificial liver catheter-related bloodstream infections,reduce the occurrence of artificial liver catheter-related bloodstream infections,and improve the nursing staff's catheter maintenance ability.

关 键 词：人工肝支持系统 置管 感染 医疗失效模式与效应分析 

分 类 号：R47[医药卫生—护理学]